The Laurels

The Laurels is a residential care home providing accommodation and personal care to up to 11 people. The service provides care and support to older people some of whom live with dementia. At the time of our inspection there were 10 people using the service.

People’s experience of using this service and what we found

People were kept safe in the service by enough staff who knew them well and who had the right skills, experience and knowledge to look after them. People told us they felt safe receiving the service.

Policies and systems were in place to help protect people from the risk of harm, abuse, and improper treatment. Risks had been identified to both those people who used the service, and staff. Medicines were administered following best practice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s needs were assessed including risks to people’s health and the environment they lived in and they were monitored to ensure safety. The service was well maintained, clean and homely. Staff received training, guidance and support to do their job well.

The manager delivered an effective service because they worked in partnership with other health care professionals. There were up to date systems in place to monitor the quality of the service and any learning was identified and acted upon and the registered manager understood their regulatory responsibilities.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Laurels on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider followed current government visiting guidance. They ensured that safe visiting arrangements were in place. Visiting procedures included ensuring visitors had a confirmed negative lateral flow test, used hand sanitiser and wore a face mask.

Visiting was supported and encouraged by the home. The provider knew how important visits were to people’s well-being and emotional needs. People told us they regularly received visitors. The visitor’s book showed that there had been numerous visitors entering the home. People’s relatives spoke positively about the visits they had enjoyed with their loved ones. People who had relatives and friends that were unable to visit regularly were supported by telephone, video calls and letters to keep in touch with them.

People using the service and staff had access to regular testing for COVID-19. Any staff or person who had tested positive, isolated in line with government guidance.

The infection control policy was up to date. All staff had received training about COVID-19, infection prevention control (IPC), hand washing and in the use of personal protective equipment (PPE). The provider carried out monitoring checks of staff IPC practice and further training was provided when needed. This helped to assure the provider that people were protected and safe.

The provider had ensured that they always had a suitable supply of PPE including face masks, disposable gloves and aprons. This minimised the risk of spread of infection in the home and people and staff becoming unwell.

During the pandemic the provider ensured they kept up to date with all relevant guidance to do with the pandemic. They ensured that updates were promptly communicated to staff, people and relatives. This and regular communication with the host local authority, public health teams, community healthcare professionals and managers from other care homes helped to ensure the home carried out good IPC practice that kept people safe.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good, and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People using the service told us that they felt safe, were happy living in the home and satisfied with the care and support that they received from staff.

Staff were knowledgeable about people’s needs and engaged with them in a respectful, sensitive and encouraging manner. Staff had a caring approach to their work and understood the importance of treating people with dignity, protecting their privacy and respecting people’s differences and human rights.

People's care plans were personalised. They included details about people’s, background, individual needs and preferences. Care plans included guidance for staff to follow to ensure that people received the care and support that they needed in the way they wanted.

People had the opportunity to take part in a range of activities that met their preferences, interests and needs.

Appropriate staff recruitment procedures were in place so that only suitable staff were employed. Staffing levels and skill mix were flexible and ensured that people always received the assistance and care they needed.

Staff received the training and support that they required to carry out their roles and responsibilities in meeting people’s individual needs and supporting their independence.

People’s medicines were stored and managed safely. Staff had received training in the safe administration of medicines.

People were supported to access the healthcare services they needed. The provider liaised closely with healthcare and social care professionals to ensure that people’s health, medical and care needs were met.

People’s dietary needs and preferences were accommodated by the service. People spoke highly about the meals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and their relatives knew how to raise a complaint. They told us that they were confident that the provider would listen to them and address appropriately any concern that they raised.

Systems were in place to monitor and improve the service provided to people.

Further information is in the detailed findings below.

The Laurels is registered to provide accommodation and personal care for eleven older people some of whom may have dementia. On the day of our visit there were eleven people living in the home.

The home is owned and managed by Mrs Mitchell who is registered with us as an individual provider. As she has taken on the role of manager in day to day charge of how the regulated activity accommodation and personal care is provided there is no requirement for a separate manager to be registered with us.

People were treated with respect and staff engaged with people in a friendly and courteous manner. Throughout our visit we observed caring and supportive relationships between staff and people using the service. People told us staff were kind to them. Staff respected people’s privacy and dignity.

There were procedures for safeguarding people. Staff knew how to safeguard the people they supported and cared for. Arrangements were in place to make sure sufficient numbers of skilled staff were deployed at all times. People’s individual needs and risks were identified and managed as part of their personal plan of care and support to minimise the likelihood of harm.

Care plans reflected people’s current needs. They contained the information staff needed to provide people with the care and support they wanted and required. People had the opportunity to take part in a range of activities of their choice. Medicines were managed and administered safely.

People were encouraged and supported to make decisions for themselves whenever possible and their independence was upheld and promoted. People were provided with the support they needed to develop and maintain links with their family and friends.

People were supported to maintain good health. They had access to appropriate healthcare services that monitored their health. People were provided with appropriate support, treatment and specialist advice when needed. People had a choice of meals, and snacks were available at any time.

Staff were appropriately recruited and supported to provide people with individualised care and support. Staff told us they enjoyed working in the home and received the support and training they needed to carry out their roles and responsibilities in providing people with the care they needed.

Staff understood the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They knew about the systems in place for making decisions in people’s best interest when they were unable to make one or more decisions about their care and/or other aspects of their lives.

People had opportunities to feedback about the service and appropriate action was taken to address issues raised. There were systems in place to monitor and improve the quality of the services provided for people.

During the inspection we spoke with all the people who used the service. Most people were able to talk with us and answer our questions, one person communicated by gestures, facial expressions and sounds. We spent time observing and we spoke with three care workers, a senior care worker, the registered manager and two relatives of people who used the service. The registered manager is also the owner of the care home.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People who used the service told us that they felt safe and staff were friendly. We spent a significant part of the inspection observing people and staff. We found that people who used the service approached staff without hesitation. Relatives of people who used the service told us that they felt confident that people were safe. A person's relative made the comment 'I feel (their relative) is safe, I know that I would be informed if there was an incident.'

People's relatives spoke about the relaxed and welcoming atmosphere of the home. They commented that the 'atmosphere is lovely,' and they were 'delighted' and 'very happy,' with the service.

Staff understood their role in safeguarding people whom they supported and they understood the whistleblowing policy.

The service had systems in place to identify assess and manage risks related to the health, welfare and safety of people who used the service.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The registered manager told us that no applications for deprivation of liberty have needed to be submitted. However, we were informed by staff that people living in the home needed continuous supervision and control, and due to risk to their safety people were not free to leave without staff or others accompanying them. This may mean deprivation of liberty authorisations were required.

Checks of the environment and equipment were carried out. However, we found that a step located in the home was not easily identified, which could mean that staff and visitors were not protected against the risks of tripping.

We saw evidence that necessary employment checks had been carried out to ensure that people were cared for by suitably qualified, skilled and experienced staff.

Is the service effective?

People told us that they were happy living in the home and received the care and support that they wanted and needed. Comments from people about the staff included 'They help me when I need it, but they also let me do things for myself,' and 'They are very kind here.'

People's health and care needs were assessed with the involvement of people who used the service and their relatives.

Staff told us that they were very well supported by the registered manager and there was good communication amongst staff about the service and people's needs, which enabled them to carry out their roles effectively in providing the care and support people needed.

People's care needs had been comprehensively assessed and care and treatment was planned and delivered in a way that promoted people's safety and welfare. Risk assessments had been carried out where necessary. Care plans had been regularly reviewed and included information about people's preferred routines and healthcare needs. However, it was not always evident from records that people had participated in the review of their needs.

We saw that people's care plans included information about people's mental state and cognition. However, not every person had received a mental capacity assessment therefore there was a risk that decisions were made for people without consideration of their best interests.

Staff, family members, healthcare and social care professionals were involved in decisions about people's care. Relatives of people who used the service told us that they were kept well informed about people's progress. A relative told us that the registered manager 'keeps me informed and lets me know if there is any problem, I can speak to her at anytime.'

Is the service caring?

We saw that people were supported by kind attentive staff. Staff responded promptly when people asked them for assistance.

People who used the service were able to do things at their own pace and were not rushed. People's privacy and dignity were respected. Arrangements were in place to ensure that people's religious and cultural needs were met. People took part in a range of activities of their choice.

Relatives of people who used the service commented 'I can't praise the home highly enough,' 'The staff are lovely and friendly,' and 'We are absolutely delighted.'

Is the service responsive?

People's progress was monitored closely. Staff told us that people's care and support needs were discussed by staff during each shift which meant that they were aware of any change in people's needs. We heard staff asking people how they were. People told us that they were listened to and felt involved in their care.

Relatives told us that they frequently discussed their relative's progress with the registered manager.

People who used the service and relatives we spoke with told us that if they had any concerns or complaints, they would feel comfortable raising them with staff and the registered manager at the home.

Relatives and people who used the service told us that they were listened to and staff and the registered manager responded appropriately to feedback and any questions that they had about the service .

Is the service well-led?

The registered manager had owned and managed the home for many years. She was knowledgeable regarding her role and responsibilities. There were arrangements in place to monitor the quality of the service and checks of the environment and equipment had been carried out. There had been few incidents and accidents. These had been responded to appropriately.

The service worked well with other agencies and services to make sure people received their care and support in a joined up way. People's health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals.

Staff meetings took place regularly so staff views about the service were taken into account. Staff were clear about their roles and responsibilities. Appropriate checks had been undertaken before staff began work.

Relatives and people who used the service informed us that they were happy with the service provided by the home. They told us that they were 'very happy,' and would recommend the home to others. One person who used the service told us that the home had been recommended to them and that it 'suits me very well.'

People were supported to make choices. These included decisions about what they wanted to do and when they wanted to go to bed. Staff interacted with people who used the service in a respectful and sensitive manner. Comments from people who used the service included, 'The staff are friendly,' 'The home is very well managed,' and 'I can't fault it.'

Each person who used the service had a plan of care that included up to date information about the individual support and care they needed. People's health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals. Staff received appropriate training to enable them to have the skills to meet people's needs and appropriate systems were in place to manage people's medication.

There were systems in place to ensure that the quality of the service was monitored and improvements were made when needed.